IV Contrast Extravasation

MANAGEMENT (long version)

Evaluation:

Because the severity and prognosis of a contrast medium extravasation injury are difficult to determine on initial evaluation of the affected site, close clinical follow-up for several hours is essential for all patients in whom extravasations occur.

Elevation of the affected extremity above the level of the heart to decrease capillary hydrostatic pressure and thereby promote resorption of extravasated fluid is recommended, either warm or cold compresses.

Outpatients:

Outpatients who have suffered contrast media extravasation should be released from the radiology department only after the radiologist is satisfied that any signs and symptoms that were present initially have improved or that new symptoms have not developed during the observation period. Clear instructions should be given to the patient to seek additional medical care, should there be any worsening of symptoms, skin ulceration, or the development of any neurologic or circulatory symptoms, including paresthesias.

Surgical Consultation:

Prior to discharge should be obtained whenever there is concern for a severe extravasation injury. An immediate surgical consultation is indicated for any patient in whom one or more of the following signs or symptoms develops: progressive swelling or pain, altered tissue perfusion as evidenced by decreased capillary refill at any time after the extravasation has occurred, change in sensation in the affected limb, and skin ulceration or blistering.

Documentation:

Notify the referring physician, always.
Additionally, all extravasation events and their treatment should be documented in the medical record, in three places: (1) SafetyNet SafetyNet incident report, (2) A note in Epic, and (3) in the dictated imaging report of the obtained study.

Follow up with the patient in 24 HOURS!